EQUINIA

Synonyms.—Glanders; Farcy; Malleus; Fr., Morve; Farcin; Ger., Rotz; Rotz-
krankheit.

Definition.—An inoculable acute or chronic disease of malig-
nant type, derived from the horse, mule, or ass, and characterized by
grave constitutional symptoms, inflammations of the nasal and res­
piratory passages, and a vesicopustular, papulopustular, or deep-seated
tubercular or nodular ulcerative eruption.

Symptoms.—The site of the inoculation may be on exposed parts
through any break or lesion of the skin, or it may gain access through
the mucous membrane of the eye, nose, mouth, or respiratory tract.
Its port of entrance is not always ascertainable. A few days to several
weeks after inoculation general symptoms of malaise, fever, rheumatic
pains, and possibly chills or chilliness are noted. The local symptoms
at the point of inoculation are somewhat varied. The spot may heal
up and break down again, a decided phlegmonous inflammation may

EQUINIA

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show itself, or a small inflammatory, dark-red papulopustule arises and
may break down into an unhealthy-looking ulcer, which tends to spread.
Inoculation of the mucous membrane of the eye or nose may lead to
destruction of the part, which usually not only extends deeply into
the soft tissue, but may involve the bony structure. Along with the
symptoms at the site of the inoculation and the advent of systemic dis­
turbance, or somewhat later, the general surface, or parts of it, as well
as the mucous membranes, becomes the seat of somewhat flattened
vesicopustules, small or large nodules which break down and form
ill-conditioned, foul ulcers, which increase in size and may involve
considerable tissue. Large nodules (so-called farcy buds) may appear
deep down in the tissues, in the lymph-glands, and the lymphatic
channels may be thickened. Some may melt down and give rise to
abscesses and extensive destruction. The mucous membranes may
also show lesions of similar but smaller character, more especially the
mucous membrane of the nose, the latter being affected in a large number
of cases. These are apt to undergo the same destructive changes as
those upon the skin. There is at first a good deal of mucoid or catarrhal
discharge from the nose, somewhat viscid, which may later be mixed
with pus and blood. In some instances the brunt of the manifestations
is upon the mucous membranes, not only of the parts named, but also
of the intestinal tract. The constitutional symptoms may vary, but
in the acute cases the febrile action is usually continuous and becomes
more marked, the symptoms of general sepsis are added, and the patient
succumbs.

The chronic cases differ often considerably from the acute. The
lesions may be scanty in number, develop and undergo changes less
rapidly, and the accompanying constitutional disturbance is less marked.
The characters of the acute type may supervene, and the patient rapidly
die. The duration of the chronic disease may be months or longer.
Death usually results from marasmus or renal complication (Besnier).
If recovery takes place, the ulcers gradually heal and other symptoms
abate. Exceptionally apparent recovery is noted (Hallopeau), which
may last a year or more, followed finally by recrudescence and death.

Etiology and Pathology—The disease is rather rare in this
country. It is usually contracted from horses, and is seen chiefly in
those who have to do with these animals. Its transmissibility from
man to man has also been noticed in some instances. The direct
cause is the glanders bacillus (bacillus mallei), similar but smaller than
the tubercle bacillus, and found in all lesions, the blood and other tis­
sues (Schütz and Löffler, Bouchard, Capitan, Charrin). The lesions
are made up of round-celled granulation tissue, which, as in all the
granulomata, is unstable and breaks down readily.

Diagnosis.—The diagnosis is not always easy in the earliest period,
but after the cutaneous manifestations, nasal discharge, and mucous
membrane lesions have presented, the picture is sufficiently character­
istic In the earliest stage it has been mistaken for rheumatism and
typhoid fever. The chronic disease may bear some resemblance to
tuberculosis and syphilis. Now that the cause is known, in suspected

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INFLAMMATIONS

cases microscopic examination should be made for the bacillus, stain­
ing with methylene-blue; or inoculation experiments may be made.

Prognosis and Treatment.—Acute cases almost invariably end
fatally within six weeks, and some early in the attack, and even before
the skin-lesions appear; the chronic disease is fatal in about half the cases.

Treatment is purely empirical, the strength being supported, and
the lesions treated surgically and antiseptically. It is possible that the
toxins—mallein—of the bacilli may prove of service; in one case (Bon-
ome)¹ subcutaneous injections had a very favorable influence.

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